T3-4期结直肠癌中分类的壁外肿瘤沉积物和包膜外淋巴结侵犯的预后意义：一项回顾性单中心研究
Prognostic significance of classified extramural tumor deposits and extracapsular lymph node invasion in T3-4 colorectal cancer: a retrospective single-center study.
作者信息
Yamano Tomoki, Semba Shuho, Noda Masafumi, Yoshimura Mie, Kobayashi Masayoshi, Hamanaka Michiko, Beppu Naohito, Yano Aya, Tsukamoto Kiyoshi, Matsubara Nagahide, Tomita Naohiro
机构信息
Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Department of Pathology, Kobe Ekisaikai Hospital, Kobe, Hyogo, Japan.
出版信息
BMC Cancer. 2015 Nov 6;15:859. doi: 10.1186/s12885-015-1885-6.
BACKGROUND
Extramural tumor deposits (TDs) and extracapsular lymph node involvement (ECLNI) are considered to be poor prognostic factors in patients with T3-4, N0-2, M0 colorectal cancer (CRC). Although TDs are known to have multiple origins and pleomorphic features, the prognostic significances of the different type of TDs have not yet been established.
METHODS
We performed a retrospective review of 385 consecutive patients with T3-4, N0-2, M0 CRC who received curative resection at our institution between 2006 and 2012. We classified the TDs into two groups: invasive-type TD (iTD), which is characterized by the presence of lymphatic invasion, vascular invasion, perineural invasion, or undefined cancer cell clusters and nodular-type TD (nTD), which is characterized by a smooth or irregular-shaped tumor nodule other than an iTD. ECLNI was defined as invasion of cancer cells into capsular collagen tissues or adipose tissues beyond the capsular collagen. Multivariate analyses were used to assess the prognostic significance of iTD, ND, and ECLNI for relapse-free survival (RFS), disease-specific survival (DSS), and sites of recurrence.
RESULTS
In patients without lymph node (LN) metastasis, the incidences of iTD and nTD were both in the range of 2-3 %. Conversely, in patients with LN metastasis, the incidences of iTD, nTD, and ECLNI were 31, 22, and 34 %, respectively. iTD, nTD, and ECLNI were all significant independent adverse factors for RFS in rectal cancer, and were all associated with pT, pN, and LN ratio. iTD was a significant independent adverse prognostic factor for DSS in rectal cancer, metastasis to the liver in colorectal cancer, and distant LN metastasis in colon cancer. ECLNI was a significant independent prognostic factor for RFS in colon cancer.
CONCLUSIONS
Classifying TDs and assessing ECLNI may help establish significant prognostic factors for patients with T3-4, N0-2, M0 CRC.
背景
壁外肿瘤沉积物（TDs）和包膜外淋巴结受累（ECLNI）被认为是T3 - 4、N0 - 2、M0期结直肠癌（CRC）患者的不良预后因素。尽管已知TDs有多种起源和多形性特征，但不同类型TDs的预后意义尚未明确。
方法
我们对2006年至2012年在本机构接受根治性切除的385例连续T3 - 4、N0 - 2、M0期CRC患者进行了回顾性研究。我们将TDs分为两组：浸润型TD（iTD），其特征为存在淋巴血管浸润、神经周围浸润或未明确的癌细胞簇；结节型TD（nTD），其特征为除iTD外的光滑或不规则形肿瘤结节。ECLNI定义为癌细胞侵入包膜胶原组织或包膜胶原组织以外的脂肪组织。采用多因素分析评估iTD、nTD和ECLNI对无复发生存期（RFS）、疾病特异性生存期（DSS）和复发部位的预后意义。
结果
在无淋巴结（LN）转移的患者中，iTD和nTD的发生率均在2% - 3%范围内。相反，在有LN转移的患者中，iTD、nTD和ECLNI的发生率分别为31%、22%和34%。iTD、nTD和ECLNI均为直肠癌RFS的显著独立不良因素，且均与pT、pN和LN比值相关。iTD是直肠癌DSS、结直肠癌肝转移和结肠癌远处LN转移的显著独立不良预后因素。ECLNI是结肠癌RFS的显著独立预后因素。
结论
对TDs进行分类并评估ECLNI可能有助于确定T3 - 4、N0 - 2、M0期CRC患者的重要预后因素。
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